Never too old: A case of fatal epstein barr virus pneumonia in an immunocompetent adult.

A 67-year-old immunocompetent male with COPD on supplemental oxygen presented with shortness of breath and was initially treated for bronchitis exacerbation with initial suspicion of bacterial pneumonia. He was later found to have EBV pneumonia diagnosed via positive EBV on bronchoalveolar lavage PCR. Severe lung involvement has been rarely reported in context of acute EBV infection. Treatment for this entity has not yet been established, with few reports of acyclovir and steroid use. This report describes the presentation, diagnosis, and treatment of acute EBV pneumonia.

Cavitary lung lesion as sequelae of mild COVID-19 in a patient with HIV.

Cavitary lung lesions involve a large spectrum of acute to chronic infections, chronic systemic diseases, and malignancies. During the COVID-19 pandemic, we have seen an increase in lung cavitation, mainly secondary to bacterial infection however, there have been limited reports of these lesions with mild COVID-19 disease. There has been an association between severe COVID-19 infection and secondary bacterial/fungal infections and cavitary lung lesions. We report the first case of a 32-year-old man with well-controlled HIV who presented with cough and fever from what appeared to be a cavitary lesion as a sequela of his recent COVID-19 infection.

A Case of SGLT2 Inhibitor-Induced Euglycemic Diabetic Ketoacidosis.

While rare, serious adverse effects including euglycemic diabetic ketoacidosis (EDKA) have been associated with sodium-glucose cotransporter-2 inhibitor (SGLT2i) use. We present an interesting case of SGLT2i-induced EDKA occurring two years after initiation of therapy. Most patients with EDKA recover with prompt recognition and treatment. Patient education about identifying early signs remains a cornerstone of early identification and response to SGLT2i-induced EDKA.

A Chronic Obstructive Pulmonary Disease Exacerbation Following the Administration of a COVID 19-Booster Vaccine: A Case Report.

We present a case of a patient who presented to the emergency department with symptoms suggestive of a chronic obstructive pulmonary disease (COPD) exacerbation one day after receiving the BNT162b2 COVID-19 booster vaccine. Laboratory studies indicated she was in a state of inflammation, but not infection. Other potential triggers, including cardiac and viral etiologies, were ruled out. To our knowledge, this is the first documented case of a COPD exacerbation following the administration of the BNT162b2 COVID-19 vaccine.

Fungal Peritonitis Secondary to Aspergillosis in a Peritoneal Dialysis Patient.

Fungal peritonitis remains a serious complication of peritoneal dialysis that carries a high morbidity and mortality. Most cases of fungal infections are due to Candida species; however few cases are seen in the setting of non-Candida such Aspergillus, Fusarium, and Mucor. Prompt peritoneal dialysis catheter removal and early anti-fungal treatment have been considered as best strategies to improve survival. We present a rare case of a 27-year-old male with focal segmental glomerulosclerosis on peritoneal dialysis (PD) presented to the hospital recurrent episodes of abdominal pain, diarrhea, and cloudy output from his peritoneal catheter. He was found to have fungal peritonitis secondary to Aspergillosis Fumigatus. This report highlights that fungal peritonitis should be considered in the differential diagnosis of patients with prolonged antibiotic use, recent bacterial peritonitis, and recent hospitalization. The speciation of Aspergillosis Fumigatus carries a rare incidence in this population and voriconazole is the mainstay treatment.

Erratum to "Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage".

[This corrects the article DOI: 10.1155/2021/5555961.].

Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage.

Pemphigus vulgaris (PV) is an autoimmune blistering disorder of the skin and mucosal surfaces characterized by acantholysis (loss of adhesion between epidermal cells). Esophageal involvement of PV is an underdiagnosed entity as routine diagnostic endoscopy is not recommended in asymptomatic patients. Dysphagia and odynophagia are common presenting symptoms; however, upper gastrointestinal bleeding (UGIB) associated with esophageal involvement of PV without a history of mucosal blistering is extremely uncommon. We present a case of esophageal involvement of PV associated with active UGIB that was diagnosed on endoscopic evaluation. This case illustrated the importance of early endoscopy to identify the esophageal involvement of PV especially in patients with preexisting disease who present with gastrointestinal symptoms such as dysphagia, odynophagia, and hematemesis. Early recognition of esophageal involvement of PV and initiation of corticosteroid and/or immunosuppressant therapy may improve the outcome of the disease.

Catheter-Directed Therapy: Outcomes Versus Standard of Care and Evaluation of Current Practice.

BACKGROUND: Small studies have noted benefit with the use of catheter-directed therapy (CDT) versus standard of care in treatment of pulmonary embolism, but none have focused on the variability of clinical practice with this modality. METHODS: International Classification of Diseases (ICD) codes were used to retrospectively identify consecutive adult patients admitted to an intensive care unit (ICU) with pulmonary embolism over a 2-year period. We evaluated inpatient mortality and major bleeding and assessed treatment variation. RESULTS: Of 284 patients included, 46 underwent CDT (9 massive pulmonary embolism, 37 submassive pulmonary embolism). Significantly more patients who underwent standard treatment had a history of congestive heart failure and diabetes. Obesity, higher troponin levels, and right heart strain were significantly more likely in the CDT group. No significant difference in inpatient mortality or major bleeding events was observed between the treatment groups. Tissue plasminogen activator use varied widely in the CDT group, and inferior vena cava filter utilization was significantly more common in the CDT group (18; 41%) compared with the standard group (40; 17%) (P < 0.01). CONCLUSIONS: In this study, no significant difference in inpatient mortality or major bleeding was found in patients in the intensive care unit with pulmonary embolism who underwent CDT compared with standard care. It may be beneficial to standardize this procedure given the potential benefit of CDT in patients with submassive pulmonary embolism.

Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking.

Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.